Supervisor - Revenue Recovery Resolution - Ontario, CA
- Ontario, CA
The Recovery Resolution Supervisor is responsible for supervising the staff, setting goals for the team, providing process development, project management, leadership, mentoring, and training within the Revenue Recovery department.
- Expected to work as an integral member of the Revenue Recovery Management Team to identify, resolve, and apply close gap measures for all operational issues using defined processes, expertise and judgement
- Oversight for multiple areas of responsibility within the Revenue Recovery department including:
- Claims Auditing
- Billing and recovery of claims overpayments
- Investigating and pursuing recoveries and payables on Subrogation cases (Third Party Liability and Workers Comp)
- Responsible for working with the team and setting up overpayment identifiers to monitor timely and accurate job tasks
- Identify new recovery potential and develop plans to meet the short term objectives as needed by the department
- Document and communicate outcomes of claims investigation to all applicable internal and external stakeholders to facilitate resolution of overpayments
- Oversight of the design and implementation of system automation for the department
- Monitor and reconcile billing and recovery data in applicable systems
- Participate in management level meetings
- Prepare and report the month-end financials for the Revenue Recovery department
- Perform other duties as assigned
- Bachelor's degree with 5 -7 years of experience working in Managed Health Care at a Payor/Healthplan or a group with Global Risk (equivalent of 8+ years' experience without a degree.)
- 3+ years Supervising or Managing direct reports
- Experience working in the following areas is required for this position:
- Revenue Recovery
- Healthcare Claims
- Healthcare Financials
- Healthplan and Provider Contracts (DOFRs, Compensation rates etc.)
- Stop Loss Reinsurance
- Experience interpreting and negotiating Managed Care Excess Loss Insurance Policy
- Intermediate proficiency in Microsoft Excel
- Access Database experience or working knowledge of SQL
- Knowledge and experience in ICD-10 and HCPC coding
- Experience working with high volume of claims data
- Analytical and problem solving skills
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. SM
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OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
North American Medical Management, California, Inc. (NAMM) develops and manages clinician networks, offering a full range of services to assist physicians and other clinicians in their managed care and business operations. For over 17 years, NAMM has been an innovator in health care with a track record for quality, financial stability, extraordinary services and superior electronic capabilities. Prime Care Medical Network is a key affiliate.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
Job Keywords: Revenue Recovery, Managed Care, Healthcare, Supervisor, Manager, claims audit, Subrogation, Stop Loss Reinsurance, Excel, Access, SQL, HCP-10, HCPC coding, Ontario, CA, California
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